American College of Physicians policy paper recommendations consider full array of drugs, not only opioids
December 10, 2013
(Washington) - Ten policy positions and recommendations to address the significant human and financial costs related to prescription drug abuse were provided by the American College of Physicians (ACP) in a policy paper released yesterday. Prescription Drug Abuse forms a framework for patients to receive the care they require while effectively accounting for the problems associated with the use of prescription drugs - specifically those with a significant potential for abuse.
"Prescription drug abuse is found throughout all aspects of our population and is a serious public health problem," said Molly Cooke, MD, FACP, president of ACP. "Physicians and other health professionals with prescribing privileges are entrusted with the authority to use medications in the treatment of their patients and therefore have an important role to play in helping to ensure safe and effective use of this treatment option and the deterrence of its abuse."
Physicians have an ethical obligation to manage and relieve pain, but to do so responsibly and in accord with scientific evidence, according to ACP's Ethics Guidelines. Improvement in function through the short-term use of opioids and related substances to treat acute pain and their use to ease suffering at end-of-life are well-accepted medical practices. However, long-term opioid use for chronic pain is controversial because of concerns about addiction, overuse, misuse, and side effects.
The ACP paper distinguishes itself by noting that controlled substances include medications not only for the treatment of pain, but to treat sleep disorders, nerve conditions, weight loss and other conditions. Improvement in function through the short-term use of opioids and related substances to treat acute pain and their use to ease suffering at end of life are well accepted medical practices.
The paper includes a definition of drug abuse, information about prescription drug abuse in different age groups, variation by geographic area, prescription drug abuse and fraud in Medicare, and factors contributing to the dramatic rise in the availability and misuse of prescription drugs.
"ACP supports efforts to educate physicians, patients, and the public on the appropriate medical uses of controlled drugs and the dangers of both medical and non-medical use of prescription drugs," Dr. Cooke said as she cited one of the paper's recommendations.
Long-term opioid use for chronic pain is controversial because of concerns about addiction, overuse, misuse, and side effects. Long-term use can also lead to opioid-induced heightened pain sensitivity, which in turn leads to increased doses of opioids, further escalating sensitivity to pain.
Prescribing controlled substances, which can be addictive or abused, can subject physicians to substantial regulatory and administrative burdens. There are criminal and civil penalties, including loss of licensure (and consequent inability to practice) for failure to comply with state and federal laws regulating controlled substances. On the other hand, failure to adequately medicate a patient can expose a physician to malpractice charges of negligence. Physicians can also be sued for overmedication that results in addiction or serious side effects. State medical boards also report addressing complaints for both overtreatment and under treatment of pain.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 137,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.